(Trigger Warning!!!) To think labour pain is not respected by healthcare professionals?

[Goldfishshoals]

Warning: you probably don't want to read this if pregnant/about to give birth!

Three weeks ago I gave birth. I had back labour - truly agonising. The pains started on Friday, but because they were about five-six minutes apart they were arbitrarily considered 'pre-labour' rather than actual labour (despite hurting as much as 'real' labour pains). They continued like that for four days, in which time I obviously got no sleep. I called the midwife for help several times and was fobbed off with 'take paracetamol', which unsurprisingly did bugger all for the intense stabbing sensation in my back every contraction. After one call in which I cried they let me come in (30 mins car ride there and back in pain!) and have a single dose of coedine (barely took the edge off) before sending me home.

On Tuesday my waters broke so I was finally allowed in the hospital for monitoring - I pretty much immediately begged for pain relief. 'of course you can have some!' said the midwife breezily before buggering off for fifteen minutes leaving me in pain. Then she came back and said she just had to ask a few questions then 'we'd see' about getting me some pain relief... I did eventually get given some gas and air.

My contractions never became more frequent on their own and eventually I ended up being induced with epidural - which wore off just in time for me to be fully dialated. First they said they'd get me more - then they said it was too late and gave me gas and air - which they took off me again when it was time for pushing. I begged for pain relief (for anything!) and was ignored. I struggled to push but the pain was overwhelming and stopped me being able to push fully. Baby eventually delivered with forceps, and episiotomy which I could barely feel in contrast to the agony I had been in.

I had third degree tear which needed stitching, and suddenly everything changed. I had an anaesthesitist numb me fully, and keep checking my pain levels for the theatre, I had a few days in hospital with three types of pain relief thrown at me, and I was sent home with boxes of unnecessary coedine etc, for the incredibly minor soreness of the stitches.

When I compare other hospital visits (for being run over by a car as a teen, and a more recent dvt) it's a similar story. My pain was taken a lot more seriously and I was given better pain relief much more quickly, despite them not being nearly as painful as my back labour.

I realise not everyone has back labour, and some people have much less painful births (lucky cows) but surely having high levels of pain isn't that unique? So why wasn't it treated seriously? The only thing I can think of is that labour pain just isn't respected. Aibu to think this?

"And that's what you're doing when you say some women having epidurals definitely wouldn't have needed them if they were OOH."

It's absolutely logical to say that epidural use will be lower in settings where women experience lower rates of dysfunctional and prolonged labour as most epidurals are given in response to labours being more than usually challenging - as evidenced by dozens of posts on this thread.

"I don't know when you gave birth, but current NICE guidance is clear that the chances of CS don't increase with an epidural. So a desire to avoid CS isn't a reason for a woman not to choose an epidural"

I agree that epidurals don't appear to increase the likelihood of a c/s.

But labouring in an obstetric setting (which is the only place where you can have an epidural) does.

waited and waited for paracetamol and ibuprofen to be prescribed and sent DH to Asda to buy some in the end as I was beside myself. It was ridiculous. Same here!
Not only that but I was told I wasn't allowed to eat hospital food, I needed to eat something lighter, then I had to fast for 24hrs due to stomach problems - when I came off the fast I asked for food but was told there was no food for me except a packet of crisps. Care was non existent.

I'd say that your feelings about the desirability of epidurals have bugger all impact on how painful your labour turns out to be.

Clearly this is nothing more than an unverified assertion on your part and thus adds nothing to the discussion. But even if it weren't, the salient point isn't how painful the labour is, it's how the woman experiences it.

The facts are that women electing to give birth in OOH settings are less likely to have epidurals and have higher satisfaction rates than the average, wherever they eventually give birth. These are the things we know.

There are multiple possible explanations for why this could be. It could be something about the OOH setting, something about the women who choose it, or a combination of both. Anyone who thinks they can tell us which also needs to tell us why.

It's absolutely logical to say that epidural use will be lower in settings where women experience lower rates of dysfunctional and prolonged labour as most epidurals are given in response to labours being more than usually challenging - as evidenced by dozens of posts on this thread.

False. It's reaching. See my post above. In order for this to be a logical assertion, you would need to be able to show that the experiences of women who deliberately choose a non-epidural environment can be replicated amongst women who don't. To control for maternal attitude. Good luck with that one.

Mini, that's still I midwife to 12 women.

With such a low midwife/woman ratio I assume there are MSWs to help with observations/feeding?

And not all of those twelve women will have the same pain relief needs.

It's up to each midwife to identify the women who are post/op or post/instrumental and prioritise that aspect of care.

And I know how difficult it is to complain when you see midwives run ragged, and how it's the last thing women feel like doing for so many reasons, but complain complain complain- women and midwives.

Because nothing changes otherwise.

Minifingerz I have rarely seen you be anything other than patronising. I am well aware of the concept of informed decision making, my point was about how entirely differently this is conducted when it comes to pain relief in labour vs pain relief in pretty much any other situation. There is a difference between informed decision making and trying to terrify women in to not having pain relief and often it seems to fall on the wrong side of that line

"Minifingerz I have rarely seen you be anything other than patronising. I am well aware of the concept of informed decision making, my point was about how entirely differently this is conducted when it comes to pain relief in labour vs pain relief in pretty much any other situation"

Have you had a lot of medical treatment which enables you to compare practices?

Or access to research which supports your view that there is more focus on informed decision making in maternity care than in other areas of healthcare?

An epidural is a skilled medical procedure which puts the mother at (albeit remote) risk of paralysis and an increased likelihood of fetal distress.

Are you making a case that women shouldn't be informed of these risks on the basis that healthcare professionals in other areas of medicine are failing in their duty of care to inform patients of the risks as well as benefits of the treatment they're recommending, and there should be parity between all areas of medicine in relation to this issue? Like a race to the bottom?

It is logical to suggest that epidural use would be lower in settings where lower numbers experience prolonged labour.
there will be higher numbers there for what ever reason labour was so quick that an epidural was not even possible.
(One of mine I met my midwife after delivery...I didn't make the labour ward)
My neighbour didn't make her car even.
My next I stayed at home.

"There is a difference between informed decision making and trying to terrify women in to not having pain relief and often it seems to fall on the wrong side of that line"

Are you saying that HCP's exaggerate the risks, don't give evidenced based information to women, or use inflammatory language to put women off using pain relief, and that this is happening on a fairly grand scale?

The CQC survey (2015) says that nearly 9 out of 10 of women say they were 'always' treated with respect and dignity in childbirth. Suggests most women don't feel like they were lied to or patronised. It'd be better if it was 100% but the trend at the moment is upwards rather than downwards.

No I'm pointing out that when it comes to childbirth the information on risks is often delivered in a way which is unbalanced and biased and focuses only on the risks of the intervention, rarely discussing the risks of not doing it or the benefits. In many cases it's not informed decision making at all as a result.

There's women on this thread who had ptsd and psychological trauma as a result of insufficient pain relief. I've sure as hell never heard it rattled off in the pros and cons informed decision making list though. Similarly when you're given the risks of a c section to try and pressure you to go for a vaginal birth it's not a discussion to inform as it doesn't discuss the risks the other way.

Actually I'll ask the thread that one. Lots of people on here have had c sections. Particularly for electives actually, was anyone told that vaginal birth could potentially leave them torn, or incontinent, or (insert possible negative vaginal outcome here) or did the discussion about the options focus only on the risks of the section?

I delivered abroad and had a c-section for medical reasons. I was given an epidural, morphine, and panadol/codeine for afterwards. I breastfed and was told mothers who are in pain are more likely to struggle with milk coming in and establishing breastfeeding, therefore the risk of using pain medication is less than the risk of not using it. Breastfed successfully for more than 12 months.

I've also had two non-maternity operations on the NHS where I was sent home with so much codeine I briefly considered investigating its street value.

So...it does seem from a lot of comments here that there is a disregard for pain related to childbirth in the NHS.

Why wasn't I given this survey "oh wait" I had a traumatic birth, why would they give it to me.

The NHS have no money and if they can get away with giving you little medication they will.

Statistically I was only informed of the huge risks of c-section. At no time was I ever informed that there are also risks to vaginal birth. Now, I'm not clueless, I know that sometimes people sustain injury during vaginal birth, but not one medical professional mentioned complications at any stage of my antenatal care. Whereas the risks of C-section were stressed very heavily, right up to 'possibly fatal'. That bit came as they were running down the corridor with me to theatre, with someone running alongside me trying to hold the clipboard still enough for me to sign the form. Yes, it was absolutely right that they warned me of that, but I do believe that injuries from vaginal birth are neatly sidestepped.

At no point have I ever had any information from the NHS about the risks of vaginal birth. No elcs here though.

"No I'm pointing out that when it comes to childbirth the information on risks is often delivered in a way which is unbalanced and biased and focuses only on the risks of the intervention, rarely discussing the risks of not doing it or the benefits. In many cases it's not informed decision making at all as a result".

You say 'often' - have you got evidence of this?

My experience actually suggests the opposite - particularly in relation to anything associated with induction and antibiotic use in maternity care.

I have come across very few people who are aware for example that epidurals can cause a fever in labour, which can result in babies being exposed to prophylactic antibiotics (as a mum presenting with fever in labour will be treated if it isn't clear what is causing the fever).

Women are routinely told that induction doesn't increase the likelihood of a c/s, as this is what the evidence suggests. They aren't often told that if they are a first time mum that they have a 60% chance of their induction resulting in an emergency c/s or an instrumental birth. Or that a sweep may result in an accidental rupture of the membranes.

Re: informing women of the risks of any normal physiological process - going to the toilet, giving birth, walking, breathing - there is only value in doing this when you are offering an alternative: a colostomy, a c/s, a wheelchair or a ventilator. At the moment women in the U.K. aren't routinely being given the choice to avoid normal physiological functions including birth, when there is no evidence of dysfunction. There's an argument for changing that which I'm not averse to, I'm just nervous about the idea of hugely increasing the amount of elective surgery going on in our hospitals without more resources - doctors, theatre capacity, postnatal care and additional capacity on postnatal wards.

Ok my particular case as an example. I was extremely immobile, due to spd. An active labour, moving around, using a birthing pool, different positions etc were all out due to my physical limitations. The plan for making me exceed the limits of my motion to physically give birth was an epidural.
I was informed in great depth about the risks of caesareans. I asked what the likelihood was of me needing intervention given my limitations. The department's average c section stat was quoted - no mention of even the possibility instrumental delivery, no adjustment for the fact I was immobile, first time mother, be having a heavy epidural...none of it. That's not informed decision making.

Birth is already medicalised in many cases so I think it's entirely reasonable to discuss the alternatives especially as the only alternative is not just the natural physiological process but other forms of intervention.

Re: informing women of the risks of any normal physiological process - going to the toilet, giving birth, walking, breathing - there is only value in doing this when you are offering an alternative: a colostomy, a c/s, a wheelchair or a ventilator.

Well, women do at least in theory have the option of ELCS, as per NICE. But I agree, if you're not in reality being offered one, and we know women aren't always, the care provider is disincentivised to explain the risks of the only choice you're being given.

I think one thing that is emerging here is that most of us feel women need more informed consent. It is very clear that we're not being given full information.

I also think we need to be aware that women reporting good care and treatment with respect is indicative of them having been accurately counselled. I actually participated in the 2015 CDC myself, and most of my answers were positive as the particular birth I was being asked about was. Despite it being an EMCS. The poor treatment and epidural denial had come before (and frankly, I wouldn't have felt able to participate in CDC evidence gathering had I been asked to do so just a few months after that happened. There is a question over whether traumatised women are less likely to be able to participate).

Despite all this, I still wasn't aware that VB poses greater risk of some problems than ELCS at the point when I participated. And I had been attempting a VB. That knowledge came later. So I said my antenatal care had been great despite nobody having seen fit to fully inform me.

YANBU. I was demented with pain during my 2nd labour. My first was bad (back to back baby), but I was given pethidine which basically messed me up so much I could not vocalise the pain.

So for my 2nd I was not allowed pethidine, it had made me too sick and I had reacted too badly to it. I had a tens machine for first few hours and managed, but my labour went on over 3 days before an emergency C section, I was only given an epidural 3 hours before the c section, so I literally spent days feeling like I was losing my mind with the pain, it was just not addressed, I very much feel like it is expected for a woman to experience the pain regardless of the intensity. I was offered no coping mechanisms never mind alternative pain relief.

What I mean there is, sometimes it can take a while to realise something wasn't right in the way you were treated. Especially when you're operating from a position of ignorance. Which it seems many of us are, wrt childbirth.

Eg there was some inappropriate recording in my notes with one of my births, which I don't feel able to go into, but I can say that it was significant enough that it should be relevant to any assessment of the standard of my care. I didn't know about that until I requested a copy a few months later. So I obviously couldn't have mentioned it to any CDC evidence gathering exercise before that point.

No way are the surveys reflective.

I know women who haven't even remembered the trauma of their first birth until pregnant again - complete mental block. And because everyone says 'well your baby lived, that's the important thing' those women went round saying the birth was alright.

Then they got pregnant again and woke in the night with the screaming horrors.

PTSD after giving birth doesn't seem to be acknowledged as a risk at all by most HCPs.

20 or 30 women "I personally had a terrible experience"
One poster: "well, ive read a survey that says youre wrong and almost everyone says its great."

Oh if youve got a SURVEY then clearly every single person here is mistaken. I'm glad there's no possible incentive for wards to not offer these surveys to women where things went badly such as the survey figures being published and reported on...

Oh and yes there were falsehoods in my notes from my first labour which I wasn't aware of until my second pregnancy, I reckon that happens a lot.

As far as my notes were concerned there were no problems in my first labour and I was attended by a different midwife to the one I actually saw.... so that's all hunky dory then

I was told if I didn't let them do the anti coagulant injection - I'm needle phobic - then I wouldn't be allowed a c section the next time. Mature, informed and respectful dialogue right there

I'm all for informed consent. However, having a cs won't necessarily prevent you from incontience issues!
There are so many factors of which you may wish to become aware of to aid your decision making process you sort of need to do a course just to cover them all.

Where do you begin?
Have your baby at a younger age you are much less likely to have a CS.
Have a lower BMI ditto.
Information for informed consent re pregnancy?
In labour often isn't an ideal time for rational discussion - yet to do it before then you are doing a lot of if that happens then..and then that...
It's not an easy line to tread.